Terry Hnath Chisolm - PhonakPro...`Lynette Dornton, Au.D. Student, University of South Florida `This...

Terry Hnath Chisolm

Hearing Care for Adults 2009The Challenge of AgingNovember 16-18, 2009

Chicago, IL

This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, and Office of Research and Development, Rehabilitation Research and Development Service and, in part, by Phonak Corporation.

Rachel McArdle, Ph.D., Chief ASPS, Bay Pines VAHC, Bay Pines, Florida

Lynette Dornton, Au.D. Student, University of South Florida

This material is the result of work supported with resources and the use of facilities at the Bay Pines VA Healthcare SystemPortions of this work were supported by Phonak CorporationThe contents do not represent the views of the Phonak Corporation and/or the Department of Veterans Affairs or the United States Government

0

30

6090

120

150

180

210

240270

300

330

60

40

20

0

Directional MicrophonesDigital Noise Reduction

Distance4 ft.

54 dBA54 dBA48 dBA48 dBA42 dBA42 dBA

8 ft.

16 ft.

32 ft.

75 dBA75 dBA

60 dBA60 dBA

Arthur Boothroyd: with permission

Free fieldEnclosed space

Reverberation

Direct sound

Reverberation


Noise: External &

Internal

Internal noise

Heating, ventilation, &air-conditioning noise

Air-borne noise

Air-borne noise

Structure-borne noise


1)

With one companion in a noisy restaurant◦

Mark’s wife often reminds him to bring his FM when they go to a restaurant as it make life not only easier for him but also for her.

2)

With another couple in a restaurant◦

FM must be placed in a strategic location, as close to everyone as possible. While far from perfect, it works better than trying to hear 3 other people with hearing aids alone.

3)

Driving in a car◦

Not a good idea to watch the lips of the speaker–

Safety more important than communication.

◦

Use of FM system allows the passenger to talk to the driver without the river taking his or her attention off the road.

4)

In a noisy group situation◦

Handheld FM microphone best way for a hard hearing person to function tolerably

◦

Takes a bit of assertiveness

◦

Communication is a two-way street

◦

Person with the hearing loss bears the greatest responsibility

5.

Watching T.V.◦

Both at home and while traveling◦

Wife can read while Mark watches T.V.

6.

Many other situations:◦

Small meetings◦

Walking down street in noisy city◦

Lectures◦

Tours◦

Etc.

FM

Noise


Are outcomes of FM use better than outcomes for hearing aid alone use in older adults?

Does age influence outcomes of FM use?

Exploratory re-examination of data from:

◦

Dornton, L. (2009). Outcomes of FM use in adults with custom hearing aids. Unpublished Doctor of Audiology Project, University of South Florida.

All males recruited from Bay Pines VAHCExperienced hearing aid users (at least 1-month with current custom hearing aids)◦

(D-mics and t-Coils)

Reporting a problem FM may assist

Randomly assigned◦

Hearing Aids Alone (HA; n = 18)

◦

Hearing Aids + FM (HA+FM; n = 18)

Age Range: 53-85 y/o◦

HA-Only: Mean = 76.6 y/o (SD = 6.8)◦

HA+FM: Mean = 72.5 y/o (SD = 9.5)

< 70 y/o (n= 8)◦

HA-alone (n = 3)◦

HA+ FM (n = 5)

70-79 y/o (n =16)◦

HA-Alone (n = 7)◦

HA+FM (n =9)

> 80 y/o (n =12)◦

HA-Alone (n =8)◦

HA+FM (n =4)

Hearing Aids

Hearing Aids NumberINTERTON INSTINCT NS30 ITC 1INTERTON INSTINCT NS40 HS 4 4INTERTON INSTINCT NS60 FS 1MICRO-TECH RADIUS 12 HS 4 4MICRO-TECH RADIUS 12 ITC 1MICRO-TECH RADIUS 12 ITE 3 3MICRO-TECH RADIUS 16 HS 2 2MICRO-TECH RADIUS 16 ITE 3 3PHONAK CLARO HS 1PHONAK PERSEO 23 DAZ HS 3 3PHONAK SAVIA 33 DSZ FS 3 3SIEMENS ARTIS ITC 1SIEMENS ARTIS HS 1SIEMENS MUSIC D FS 1SIEMENS TRIANO HS 1SIEMENS TRIANO ITC 1SIEMENS TRIANO ITE 3 3STARKEY DESTINY 1600 ITE 1UNITRON EVO FS 1Total 36

The MyLink- FM receiver which uses induction loop technology to interface with any hearing aid containing a telecoil

ZoomLink- FM transmitter with Omni-Zoom- and SuperZoom capabilities

MyLink

ZoomLink

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM

Complete Outcome Measures

Offered FM system

Offered to continue FM use

Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Research Visit #1

HA HA+FM

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Research Visit #1

HA HA+FM

Obtained Goals

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Able to hear and understand the wife whileat a restaurant

Able to understand wife when she is drivingthe car.

Understand T.V. at a level that is comfortable for wife

H. Dillon (NAL) et al

Age GroupHA HA+FM HA HA+FM HA HA+FM

1 or 2 Quiet 7.1% 5.0% 4.5%1 or 2 Noise 12.5% 14.3% 15.0% 16.0% 18.2% 18.2%Group Quiet 12.5% 4.0%Group Noise 50.0% 28.6% 50.0% 32.0% 36.4% 18.2%TV/Radio 12.5% 21.4% 20.0% 24.0% 13.6% 36.4%Telephone 4.5%Meeting 12.5% 28.6% 10.0% 4.0% 4.5% 9.1%Other 20.0% 18.2% 18.2%

Research Visit #1

HA HA+FM

Obtained GoalsBaseline Outcome Measures

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Ability to meet individualized goals of device use (Client Oriented Scale of Improvement; COSI; Dillon et al., 1997)

Satisfaction with devices (MarkeTrak; Kochkin, 1990)

Benefit in terms of self-perception of reductions in restrictions in auditory abilities (Speech, Spatial, & Qualities Questionnaire, SSQ; Gatehouse & Noble, 2004)

Research Visit #1

HA HA+FM


HA use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


Willingness to Pay

F/U FM fitting

2 wks 2/4 wks

Systematic Counseling, coaching, and instruction (30-45 min)(Chisolm et al, 2007)

Oral Written

Demonstrate appropriate use of devices for various listening situations

Helps the patient remember instrument system options and settings.Easily carried in a pocket Quick reference guide Reduces new user frustrations

Turnto

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

2 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Interim Phone Call

HA and HA+FM

users called

2 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

2 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

2 wks

5 total interim visits

4/5 (HA+FM)

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM

2 wks 2/4 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


2 wks 2/4 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system

2 wks 2/4 wks

Research Visit #1

HA HA+FM


HA use

FM Fit

HA+FM use

Research Visit #2

Interim Phone Call

HA and HA+FM

users called

Problems Reported=

Interim Visit

HA HA+FM


Offered FM system


2 wks 2/4 wks

Hearing Aid Use Alone (HA)Hearing Aid + FM System (HA+FM)

Able to hear and understand the wife whileat a restaurant




13

5

Able to hear and understand the speaker atmonthly men's club meetings at church.




13

5

Selected items from MarkeTrak Survey [Kochkin, 1990]

• Device Features• e.g., visibility, reliability, natural sounding, etc

• 16 items

• Various Listening Situations• e.g., watching TV, riding in a car, etc• 14 items

Very VeryUnsatisfied

Satisfied

1 3 5

50-item questionnaire (Version 3.1)◦

Speech: 14 items◦

Spatial: 17 items◦

Other “Qualities”: 19 items

Individual item scores

Average Speech, Spatial & Qualities Scale Scores

10 Pragmatic Scale Scores

4 Pragmatic Speech Scales◦

Speech in Quiet◦

Speech in Noise◦

Speech in Speech Contexts◦

Multiple Speech-Stream Processing and Switching

2 Pragmatic Spatial Scales◦

Localization◦

Distance and Movement

4 Pragmatic Other Qualities Scales◦

Sound Quality and Naturalness◦

Identification of Sound and Objects◦

Segregation of Sounds◦

Listening Effort

Speech Context Multiple Speech Streams

Sound Quality & Naturalness Listening Effort

Decision to keep FM devices beyond trial period

16 of 18 elected to continue use of FM systems at trial end!

1 in 80+ y/o group1 in < 70 y/o group

Are outcomes of FM use better than outcomes for hearing aid alone use in older adults?


Are outcomes of FM use better than outcomes for hearing aid alone use in older adults?◦

YES

Individualized Goals (except groups in noise)Satisfaction Benefit

Cognitively challenging speech understanding conditions and Listening Effort


No, for meeting Individualized GoalsYes, Satisfaction increasing as mean age increased


Yes, with Benefit decreasing as mean age increased for:

Speech in Speech ContextsMultiple Speech Stream Processing and SwitchingListening Effort


Benefit decreasing as mean age increased

Not surprising finding

SNR-50 increased as mean age increasedRole of cognitive functioning

Older adults can benefit from FM use

Optimize outcomes:

◦

Counseling, coaching, instruction

◦

Additional intervention approaches:Auditory-visual perceptual trainingConversational fluency training

Dillon, H., James, A., & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several others measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology . 8, 27-43.Gatehouse, S., Noble, W. (2004). The Speech, Spatial and Qualities of Hearing Scale (SSQ). International Journal of Audiology, 43, 85-99.Kochkin, S. (1990). Introducing MarkeTrak: a consumer tracking survey for the hearing instrument market. Hearing Journal, 43, 17.27.Pichora-Fuller, M.K., & Singh, G. (2006). Effects of age on auditory and cognitive processing: Implications for hearing aid fitting and audiological rehabilitation. Trends in Amplification, 10, 29-59.Ross, M. (2004). Listening with a “Third” Ear: FM Systems. Downloaded from: http://www.audiologyonline.com/articles/pf_article_detail.asp?article_id=561.

http://www.audiologyonline.com/articles/pf_article_detail.asp?article_id=561

Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51Slide Number 52Slide Number 53Slide Number 54Slide Number 55Slide Number 56Slide Number 57Slide Number 58Slide Number 59Slide Number 60Slide Number 61Slide Number 62Slide Number 63Slide Number 64Slide Number 65Slide Number 66Slide Number 67Slide Number 68Slide Number 69Slide Number 70Slide Number 71Slide Number 72Slide Number 73Slide Number 74Slide Number 75Slide Number 76Slide Number 77Slide Number 78Slide Number 79Slide Number 80Slide Number 81Slide Number 82Slide Number 83Slide Number 84Slide Number 85

Terry Hnath Chisolm - PhonakPro...`Lynette Dornton, Au.D. Student, University of South Florida `This...

Documents

Transcript of Terry Hnath Chisolm - PhonakPro...`Lynette Dornton, Au.D. Student, University of South Florida `This...